Provider Demographics
NPI:1609315290
Name:WILSON, SUSAN SONNICHSEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:SONNICHSEN
Last Name:WILSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 TOWER OAKS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4265
Mailing Address - Country:US
Mailing Address - Phone:301-593-6554
Mailing Address - Fax:301-754-1034
Practice Address - Street 1:8401 CONNECTICUT AVE STE 1120
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-5846
Practice Address - Country:US
Practice Address - Phone:301-593-6554
Practice Address - Fax:301-754-1034
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05902103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent